Ligature-tier



June 26, 1962 E. c. WOOD 3,040,747

LIGATURE-TIER Filed March 10,*1959 5 Sheets-Sheet l 8O s4 mls/22mg@ 6G FI@ Z 68 y or, L02

Er'nesC Moa BY l 77% M `lune 26, 1962 E, C, woon 3,040,747

LIGATURE-TIER Filed March lO, 1959 3 Sheets-Sheet 2 INVENTOR.

Errfes C. T/Ifooc June 26, 1962 E. C. WOOD 3,040,747

LIGATURE-TIE-R l Y Filed March l0, 1959 5 Sheets-Sheet 5 rates Y 3,040,747 LrGA'rUnn-rmn Ernest C. Wood, 6363 Wilshire Blvd., Los Angeles 48,V

Calif., assignor of thirty percent to Adolph M. Brown and thirty percent to Rene G. Le Vaux lFiled Mar. 10, 1959, Ser. No. 798,476 14 Claims. (Cl. 12S- 326) of the instrument in tying blood vessels. For example,

in the prior instrument, the operation of the guillotine required a separate movement of the thumb for operation to sever the tied ligature. This movement was time consuming and sometimes awkward to achieve.

Since the carriage on the ligature tier is moved toward the handle during its operation, it was believed possible to make use of this movement in actuation of the guillotine, whereby the above-described separate thumb movement could be eliminated. Accordingly, the actuating portion of the guillotine was placed near the handle portion of the ligature tier in the path of the carriage so that after the carriage was moved a predetermined distance toward the handle to tie the ligature, it could engage the actuating portion to operate the guillotine.

Adoption of this concept introduced other problems. The prior ligature, as described in the above-mentioned copending application, comprises a piece of string-like material with an adjustable loop at one end and a fixed loop at the other end. The fixed loop was attached to a hook mounted on the carriage of the ligature tier, and the above-described change made it necessary to limit the length of the ligature between loops. For example,

if this distance was too short, the adjustable loop would be pulled ott the instrument and tightened around the blood vessel, before the carriage had travelled the distance required to actuate the guillotine. The additional travel added strain on the ligature suiiicient sometimes to cause the adjustable loop to sever the blood vessel.

What is needed, therefore, and comprises an important object of this invention, is a ligature tier which both ties of the ligature tied around the blood vessel from the ligature tier in one simple operation. n

Another object of this invention is to provide a ligature tier which has means for limiting the tension in the ligature introduced by the operation ofthe ligature tier, to prevent the ligature from breaking, or from being tied around the blood vessel so tightly as to cut or tear.

the vessel.

Still another important object of this invention is to provide a ligature tier and a ligature Which is mounted on the ligature tier in such manner as to minimize the importance of the length of the separation between the adjustable loop and the portion attached to the ligature tier.

Further problems existed with respect to the characteristics of the ligature employed with the instrument. The use of a ligature formed of resilient material enables the ligature to act as a stretched rubber band which could y E the hook when the end is freed lby the cutter. Thus, another important object of this invention is to provide a ligature tier embodying means for holding the hooked portion after it has been severed.

Stilll another problem stemmed from the inability easily and rapidly to mount the ligature on the instrument,

tent

and it is an object to provide means for simply and eficiently maintaining the ligature in position of use on the instrument.

All of these problems have been eliectively overcome by elimination of the'xed loop on theY ligature andby substitution of a spring-urged clamping member instead of the fixed hook on the carriage. In the absence of a iixed loop, an axial opening can be formed'in the nose or iixed clamping jaw of the instrument-to enable the ligature to be threaded on the instrument.

Another object of this invention is to provide a ligature tier which in appearance and in clamping operation resembles the conventional hemostat clamp, to which the art has become accustomed. ,Y

Yet another object of this invention is to provide a ligature tier having means for adjusting the tightness t0 which the ligature is drawn about the blood vessel.

A further object of this invention isY to provide a ligature tier which can be operated by either hand in use.

These and other objects "of this-invention .will become more apparent when read in the light of the accompanying a ligature around a blood vessel and separates the portion of FIGURE 2;

drawings and speciiication wherein:

FIGURE 1 is a side elevational View of the improved ligature tier with themovement of the clampingV jaws shown in dotted lines;

FIGURE 2 is an enlarged side sectional View ofthe portion of the ligature tier shown in FIGURE 1 showing details of the clamping jaws;

Y FIGURE 3 is an enlarged side sectional view ofa por-V tion of the carriage and the guillotine, operating leverl mounted in the handle of the instrument;

YFIGURE 4.is aside elevational View of the ligature n tier, showing the adjustableligature loop pulled tight;

FIGURE 5 is a plan Aview of the ligature tier shown in FIGURE 4 and showing -theguillotine knife riding in a guide groove;

FIGURE 6 is a sectional view taken onthe line 6-6 AFIGURE 7 is a sectional of fFIGURE 2;

FIGURE 8 is a sectional view taken on the line S-S of FIGURE 2; t

`View takenvon the line'7-7 FIGURE 9 isa sectional view taken on theiline 9---9v of FIGURE 3;

FIGURE 101s a sectionn view faken on the une 1er-10v of FIGURE 3,; f

FIGURE l1 shows a'ligature mounted on a disposable string support prior to installation on thevinstrument;

FIGURE l2 is an end view of the ligature and string support; j V v l FIGURE 13 is a side view of the ligature alone, with the string support removed; and Y FIGURE 14-` is va planview of the ligature shown in FIGURE 13. A

Referring now to FIGURE 1 of the drawing, the improved ligature tier, indicated generally by the reference numeral 10, comprises a main support bar 12. This support bar is illustrated as being substantially rectangular in cross-section, although other shapes may prove to be useful.k A first handle portion 14V comprising identical side plates 15 is secured by any conventional means, such as screws, in spaced parallel relationship to the opposite sides of one end of thesupport bar.

18, for purposes to =be described below.

A movable clamping jaw 2.0 is pivotally connected to 'j the support bar 12 on pivot Z2 and is positioned opposite l4,6 and extends toward the clamping jaws 2li-jas shown..V

une 2.f A beweer ieafspnngsz isfnidmiten new .eil5

abutments 84,andgr.oove 8 6formed on -theuppper, surfaeew vof the carriage, see FIGURES. 'The bowedV leafspring.

. 3` Y to the ixed clamping jaw 18 to provideV a pair of clamping jaws V24 adapted to hold a blood vessel therebetween,

`see FIGURE 4. As seen, these clamping jaws areV disscissors-like, substantially conventional hemostathandle 29, seeV FIGURE 1. The thumb-receiving opening 28 is somewhat largerthan the finger-receiving opening`16 to accommodate' the greater thickness of the thumb. `Fur thermore, lthe thumb-receiving opening is somewhat lelongated and thrust somewhat forward on the instrument. In addition, -its `long axis is in the same plane as the long axis of the finger-receiving opening 16 andl the longitu` dinal axis of support bar 12; This arrangement permits the ligature tier to housed equally well in each hand for the convenience of rightor left-handed surgeons.

A lug 30 provided with a Yplurality of notches extends upwardly from handle portionr 14 to meet a notched lug 32 depending vfrom'v handle portion 26. 'I'he vnotches on these lugs are adapted to engage each other to provide a4 conventional ratchet-like catch for keeping the clamping jaws closed with whatever degree of compression is necesj A carriage, indicated generally by the reference numeral 34, comprises parallel top `and bottom walls 36 and 37,

and-parallel sides 38 and 40, see FIGURE 9. Side 40 is formed by flanges which extend toward leach other from the top and-bottom walls 36 and 37,7andfdet`1ne-a. side opening 42. kThis arrangement establishes a longitudinal opening 44 extending through the carriage 34, which is substantially rectangular in VVt'zross-sectionwand through Y -which the support 12 extends.

' 44 is such that its inner surfaces are in sliding engagement 4with-'the-external surfaces of support 12. This arrange- The size of the opening A The top surface 88 of support 12 is provided with a longitudinally extending groove or guide path 90, see FIGURES 3 and 8. As seen in, FIGURES v1 and 5, this groove extends substantially the length of the support 12.

' A exible blade 92 substantially. equal in length to groove 9@ is slidably mounted theerin. The blade is provided with a cutting edge 94V disposed adjacent the clampingv jaws 24, see FIGURE 2. The opposite end of the blade 92 is enlarged at 96, see FIGURE 10, and this enlarged end is provided with an'openingl 98 extending therethrough. Y

The handle portion 14 is, provided with a second opening 160 extending therethrough which is transverse to the support,y 12,* see FIGURE 3. A two-armed actuating lever 102 is mounted in thisopening on a pivot pin N4 for limited pivotal movement. One arm llily of this lever extends throughopening 93 in the enlarged portion 96 of the cutting blade 92 to pivotally connect the lever Vlltl'2`to this end ofthe cutting blade, see FIGURES 3 and 1G.' The other arm 108 extends out beyond the openingk deiinedby the spaced parallel forward edges 1.1()I of the side plates 15 of the handle portion 14, when the cutting blade 92 is in a non-'cutting position, see FIGURE 1.

A Vcoil spring 112 is mounted with one end in a recess 114 in the handle, bearing against its bail 116, see FIG- URE 3, while the other end bears against lever-arm 108, biasing it to the position shown in FIGURE l, wherein the cutting blade 92 is in a non-'cutting or retracted posi- Y tion, see VFIGURES land 2. Itis apparent, however,

that when carriage 34 is moved Vtoward handle 29, the lever-engaging surface Si) on the trigger-shaped member 46 willmove into engagement with lever arm 108 of lever 102, pivotingeit in the counter-clockwise direction, see FIGURE 3,so that lever `arm 106 `forces the cutting bladeSlZy forwardly to its cutting position at the exit 21 of'opening 18.

The improved ligature is designed for use with the improved ligature tier 10 described above, and is indicated Y generally by the reference numeral 120. As seen in FIG- ment permits the carriage 34 to .slde on support 12, butV linger-receiving. opening 4S. In addition, this/trigger-V shaped member is provided with a lever-'engagingsurface for purposes tobe described below. `An 'indexing spring 52 is also mounted on the trigger-shaped member 4The top surface 36 of the carriage basan elongated portion 54 extending `toward the clamping. jaws 24, see FIGURE 2. This elongated portion is'provided with rial, decreasing'the size of the adjustable loop until the' URES 13 and 14, this ligature comprises a piece of stringlike material with a slipknot 121 formed there-in to provide an adjustable loop 122. The knot is tied so that end 1240i the string is very short, while end 126 is comparatively long. When the adjustable loop 122 surrounds an Varticle to be tied and if the end portion 126 is pulled, the slip knot will move along the string-like mateloop 122'h`ghtly embraces the article. It is to be understood, howeven that adjustable loops can be formed in spaced parallel flanges 56-whichl merge into spaced paral-` i .lelbearing lugs 58, see FIGURES 7 and 8. The. sides kofthe extreme end portion 6G ot theellongatedportion 54 of the carriage converge together, and'this ,convlgent portionI is provided with alongitudinally extending guide opening 62 extending therethrough.Y As seen FIG- URQES ,2 "andk 6,l opening 62 is aligned` with vopening 19 in the tip of theY clamping jaw 1,8, for purposes to beidey scribed below. v Y i Y 'i A clamping lever 64 is 'pivotallyrnounted onraipivot Y shaft 66 which extends throughlu'gs 58, seejFIGURES 1 and 2. This Vclamping leveriszprovidedwith-an act'nat` Y ing arm Gtwancifa clamping arm 705,AV Theclampingarm',A l0 cooperates "withavplanar lclamping surfaceformedj Y on thetop ofthe elongated portion of thecarriage for` holding a portion of f ,heli'gaturel therebetween, see FIG'-;

82 engages, ,the actuating @11.63 the-desiring lever 64 engagement with surface V80.

string-like material by other means than by the use of knots and the claims should be construed accordingly.

The ligature 12%? is held in the position shown in FIG- A"URE'13, when it is mounted on the ligature tier. As a help 1n loading or mounting the ligature on the instrument, the'ligature may be pre-tied and mounted on a disposable string support or guide 128, see FIGURE 11.

This stringsupport comprises. an elongated portion 129 and a transversely extending enlarged portion 130'disposed at one end thereof. The string support may be formed from stili paper, folded as shown in FIGURE l2.

The ligaturek 120 is mounted so that its elongated end portion 126 penetrates between the sides of the string support adjacent the crease of the fold, see FIGURE 1l, and is held there by any conventional means. The adjustable loop 122 is mounted with the slip knot 121 near the entrance to the elongated portion 129 of the string support 128, as shown in FIGURE .171, and the opposite end 132 ofthe loop 122 is in the corner 134 deiined by the l intersection of the side 13d-of the enlargement 130 with the side131 of the elongated portion 129. The size of the adjustable` loop 122 isarranged so thedistance between they slip knot 121 yand the opposite end 132 of the `loop 122 is less than the distance, between the slip knot 121 andthe farthest transverse point 1380i the enlargement 130, .so that the adjustable loop isloeked in the corner 134. V.As stated above, the string support .V128

holds the ligature 13G in the proper position for mounting on the ligature tier 10, so when it is removed the ligature can be rapidly mourned on the ligature tier.

To install the ligature 124i on the ligature tier 10, the ligature, which is pre-tied, and which is mounted on the string support 128 prior to use, is lirst removed from the string support. It will then be in the position shown in FIGURE 13. Next, carriage 34- is moved toward the clamping jaws 24 to its loading position. This position is precisely located by means of the indexing notch 53, see FIGURE 2, so that when the carriage is moved forwardly toward the clamping jaws 24, the Atip S5 of the indexing spring 52 will enter notch 53 to indicate that the carriage is in its loading position.

The elongated end 126 of the ligature 120 is inserted in the guide opening 19 in the fixed clamping jaw 18. At least a portion of guide opening 18 must have a diameter large enough to permit a single thickness of the suture to pass therethrough, but small enough to prevent the knot 121 from passing through, for reasons to become apparent below. Furthermore, the opening 19 is shaped so that the knot 121 cannot become jammed into it in such a way as to prevent the noose-like action of the ligature from strangulating the blood vessel. After the elongated end 126 passes'through opening 19, it penetrates opening 62 at the extreme end of the carriage 34. Then end 126 passes over the planar `clamping surface S9, see FIGURE 2. The actuating arm 63 of the clamping lever 64 isY forced down against the resistance offered by the leaf spring 82, so that the clamping arm 70; is raised enough to permit` the end 126 of the ligature 12d to pass beneath it, see the solid lines in FIGURE 2. Then When the actuating arm 68 is released, spring 82 forces lever 64 to pivot so the clamping arm 70 is forced against surface 80 on the carriage, resiliently clamping the end 126 of the ligature on carriage 34, see the dotted lines in FIGURE 2. While this is happening, the adjustable loop 122 is positioned -around the clamping jaws 24 as shown in FIGURES 1 and 2.

In operation, once the ligature tier is loaded, the -tip of the bleeding blood vessel is clamped between the clamping jaws 24, and the clamping jaws may be locked in clamping position by means of the notched lugs and 32. In this position, the adjustable loop 122 of the ligature 120, which surrounds the clamping jaws 24, will be held by these jaws in spaced external relation to the external surface of the blood vessel being tied.

Then `a finger of the hand holding the ligature -tier is inserted in opening 4S of the trigger-shaped member 46, and the handY is squeezed together in such a way as to cause carriage 34 to leave its loading position andmove toward the handle 29f As this happens, the end portion 126 ofthe ligature is pulled along with the carriage. Since this end portion 126 extends through opening 19 in iixed jaw 18, before it reaches the adjustable loop 122,;`

it can b-e seen that the initial movement of the end portion 126 toward handle 29 will pull the adjustable loop in the opposite direction toward the tip of the clamping jaws 24,l and this will continue until the loop moves off the jaws entirely and surrounds the external surface of the blood vessel being tied.

As the carriage 34 continues to move toward handle 29, the pulling force exerted by end portion 126 on the adjustable loop will gradually cause it to decrease in size until it tightly embraces the blood vessel t0 stop it from bleeding.

When the adjustable loop 122 is tightened sutlciently around the blood vessel, the lever-contacting surface 50 on the trigger-shaped member 46 will engage and depress lever arm 108 of actuating lever 102, causing the exible cutting blade 92 to move forwardly and cut-the ligature yat the exit 21 of opening 19, see FIGURES 2,3, and 4.,

With this arrangement, the single movement of the carriage 34 both ties the bleeding blood vessel, and cuts the adjustable loop 122 of the ligature away from its end portion 126 mounted on the carriage 34 of the ligature tier.

It is understood that vthe extent of the movement of the carriage 34 from its loading position, as shown in FIG- UREk 1, to the position where it engages and depresses lever arm 16S, as shown in FIGURE 4, should be regulated in accordance with the sizeof the adjustable loop of the ligature and its elongated end portion 126. In this respect the ligature 120 should be mounted on the ligature tier so that there will be no unnecessary slack between the adjustable loop 122 and the elongated end portion 126 where it is clamped on the carriage.y In addition, the size of the adjustable loop should be such that it embraces the lbleeding blood vessel with the desired force, atleast when the lever-engaging surface 50 of the trigger-shaped member engages lever arm 108, see FIG- URE 3. For a ligature of a given size, the carriage 34 should move a predetermined distance for this to happen, and this is what determines `the location of the indexing v notch 53.

As seen in FIGURE 2, the tip of the elongated portion 126 of the ligature 120 extends beyond the place where it is clamped between clamping arm 70 and the surface Sti. This permitsfa relaxation of production standards in the manufacture of the ligature, since even if the adjustable loop should tightly embrace the bleeding blood vessel before the lever-contacting surface 50 engages lever arm 16S, the resilient clamping lever 68 holding the end portion 126 of the ligature will permit the end portion to slip, so that the ligature will not break, but will be held taut on the support 12 until the lever 102 is actuated, causing the cutting blade 92 to cut the' ligature.

It is also noted that this resilient'clamping lever 64 on carriage 34 provides a means for regulating the tension of the ligature around the blood vessel. If the spring 82 is weak, the elongated end portion 126 will start to slip between the clamping arm 70Vand the surface whenever the adjustable loop 122 is tightened around the bleeding blood vessel to -an extent such that the resistance offered by the blood vessel to a tighter embrace by the adjustable loop 122 of the ligature is greater than the frictional force holding the elongated end 126 on the carriage. If spring 82 is strong, this will not occur luntil the adjustable loop is tightenedaround the blood vessel to a greater extent. A plurality of springs may therefore be supplied for controlling the tightness of the adjustable loop around the blood vessel, Vin accordance with the requirements of the blood vessel being tied. Alternatively, a conventional spring tension-adjusting means may be provided.

- In this respect, it is also noted thatthe magnitude of the biasing force on lever 68, which is supp-lied by spring 82, limits the tightness of the'ligature around the blood vessel, under all circumstances, since if he 'ligature' is incorrectly m-ade so that the adjustable Vloop-embraces the bleeding blood vessel with the requisite tightness substantially before the lever-engaging surface 50 engages actuating lever 162, the continued movement of the carriage 34 toward the handle 29 will not tighten the adjustable loop any ment is therefore to be considered as illustrative and not i restrictive and it is intended to include all changes which come within the scope and `range of the claims. Y

What is claimed is: Y Y v' l. In apparatus vfor tying a yblood vessel With a ligature having a looped vend portion and a free end portion v for tightening of the loop when drawnlcomprising'a support, a carriage m-ovably mounted, on said support for linear movement between a forward positionjrearwardly of the ligature tion, said clamping end portion having a smooth upper surface andturned from the handleportion upwardly in the direction towards the carriage and which is adapted to hold the adjustable loop of a ligature in spaced external relation to the external sur-faceof the blood vessel to be tied,'resilient holding means on said carriage adapted to resiliently hold aVV portion of the ligature on the carriage and to carry this portion with the carriage when the carriageis moved, ligature guide means in the end of the clamping end portion lforwardly of the remainder of the clamping portieriV about which the loop is adapted to be received, said ligature guide 'means adapted to have the ligature extend upwardly from the said loop to said resilient holding means whereby movement of ssidcarriage rearwardly toward the handle portion with said portion of the ligature connected thereto wouldcause said looped portion of the ligature to be displaced forwardly until it moved oil the'V support, and about the external surface of the blood vessel and tightly embraces it, and cutting means mounted on said apparatus for cutting the said portion of vthe ligature away from the adjustable lloop surrounding the tied blood Vessel. Y

- 2. The apparatus set forth in claim l including a Y trigger-shaped member rigidly connected to and dependling from said carriage so that when the support is heldV in the hand of the operator by its handle portion'a'finger v ofthe same hand can be usecltoV squeeze 'the' triggershaped member and move the carriagealong said support toward thehandle portion, whereby a ligature can be tied.

around a blood vesselV using only one hand.

Y3. The apparatus set forth in claim l'including actuating means mounted on said apparatus and in the path of said carriage whenitis moved on said support, said actuating means connected to said cutting means in such a way that when the carriage moving on the support contacts it, said cutting means is operated so that by moving said carriage until it contacts said actuating means said ligature will be tied around the blood vessel and the tied portion will be severed from the apparatus. Y

4. The apparatus set forth inclaim 3 including'a triggershaped member rigidly connected to and depending from said carriage so that when the support is heldin the hand of the operator by its handle portion a iinger of the same hand can'be usedto squeeze the trigger-shaped member and move the carriage along said support toward the handle portion, andan actuating rneans-engaging'surfa'ce formed on said trigger-shaped member, said surface con-Y tacting saidgactuatingV means to cause it to actuate saidV cutting means when said carriage is lmoved Vapredeter-V formedjonu the end of one of said clamping jaws, said liga` ture guide means adapted -to be connected to a part of the ligature in 'such a way that the'movernentV of said car` riage toward the hemostat handle with the said portion of the ligature connected thereto would cause said portion of the ligature to pull, the adjustable loop in the opposite direction until it moved oit the jaws, surroundedjthe external surface ofthe blood vessel, and tightly embraced it, and cutting means mounted on said support for cutting the said portion of the ligature away from the adjustable loop tied around the blood Vessel, said cutting means including actuating means mounted on said support and in the path of said carriage,tsaid actuating means connected to said cutting means in such a way that when the carriage moving on the support contacts it, said cutting means is actuated whereby by moving said carriage until it contacts said lactuating means said ligature loop tied around the blood vessel and the tied portion will be severed from the apparatus.

6. The apparatus set forth in claim 5 including a trig-` y, port toward the handle portion, and an actuating meansengaging surface `formed on said trigger-shaped member,

said surf-ace contacting said actuating means to cause it to actuate said cutting means when said carriage is moved a predetermined distance toward said handle' portion to operate said cutting means, whereby a ligature can be mined distance toward said handle portion whereby Va' liga- Y Ytu're'can lbe tied around theV blood vessel and outV away from the support by Vusing only one hand to hold the support land tofsqueeze the trigger-shaped*member.l i

5. An apparatus Vfor tying a yligature to ablood vessel` comprising asupport, a portion of a handle rigidlyconnected to one end of said support, said handle portion in` i cluding a iirst finger-receiving opening, a tixed,V clamping jaw formed on the opposite end thereof, a movable clamping jaw pivotally mounted on said support, said movable clamping jaw positioned opposite to said `fixed clampingl jaw to form a pair of clamping jaws .adapted to hold a blood vessel therebetween, an arm rigidly connected to Y said movable jaw and extending toward the opposite end of said support, said arm terminating'in `mother portion of a handle, said another handle portion including a second lfinger-receiving openingsaid iirst and second `fingerreceiving openings dening a scissors-like hemostat handle for the manipulation of the clamping jaws, said clamping jaws adapted to hold the adjustable loop of'a ligature in spaced external relation to the external surface ofv thei blood vessel to tbe tied, a carriage movably mounted fort lsaid support, resilient holding means on said ,carriage adapted toresiliently hold a portion of the ligature onf tied around the blood vessel and cut away from the apparatus by using only one hand to hold the apparatus and to' squeeze the trigger-shaped member.

7. An apparatus for tying a ligature to a blood vessel comprising a support, a iirst portion of a handle rigidly connected to one" end of said supoprt, said handle portion including a'iirst inger-receivin'g opening, a fixed clamping jawformed on the opposite end thereof, a movable clamping jaw pivotally mounted onY said suunort. said-movableclamping jaw positioned opposite to said fixed clamping jaw to form' a pair of clamping jaws adapted tov hold a blood vessel therebetweem'an arm rigidly connectedrto said movable jaw and extending toward the opposite end of said support, said arm terminating -in another portionV of a handle, said another handle portion including a second nger-receiving opening, said first and second linger-receiving openingsfdeiining ascissors-,likeV hemostat handle for the manipulation of the clamping jaws, said clamping jaws adapted vto hold the adjustable loop of a ligature in spaced external relation to the vexternal surface of the blood vessel to be tied, a carriage movably mountedV on said support, resilientholding means-on said carriage adaptedrto resiliently hold the portion of the ligature which when pulled decreases the size of the said adjustable loop, a guideopening 4formed v moved off the jaws, surrounded the external surface of the blood vessel, and tightly embraced it, a guide track formed on said support extending to said rigidly attached clampingY jaw, a' cutting blade movably mounted in said guide track, aztwo-armed lever pivotally mounted on said support, one arm of said lever pivotally connected to the endrof the'cutting blade, the other arm of said lever facing Asaid clamping jaws, means biasing said vlever and causing it `to pivot and move-the cutting blade to a noncuttingrvposition, a Ytrigger-shaped member rigidly connected to and depending 4from said carriage so that when the support is held in the hand of the operator by the hemostat handle a finger of the same hand can be used to squeeze the trigger-shaped member and move the carriagey along the support toward the first handle portion, a lever arm-engaging surface formed on said trigger-shaped member, said surface contacting said other lever arm when said carriage is moved a predetermined distance toward said handle to pivot said lever and thereby move the cutting blade to a cutting position, whereby a ligature can be tied around the blood vessel and cut away from the apparatus .by using only one hand to hold the apparatus and to squeeze the trigger-shaped member.

8. The apparatus set forth in claim 7 including indexing l means for locating the carriage in its ligature-loading position when a ligature is to be mounted on the apparatus.

9. An apparatus for tying a ligature to a blood vessel comprising in combination an elongated support, a carriage movably mounted on said support for linear movement between a forward position rearwardly of the forward end of the support and a rearward position, said support having a clamping end portion which has a smooth outer surface on the side adjacent Vthe carriage and which extends curvilinearly forwardly and upwardlyv in the direction towards the carriage and a handle portion, a ligature connected to and movably mounted on said support, said ligature made from a string-like material and comprising an adjustable loop withA an elongated end portion which when pulled decreases the size of the adjustable loop, said adjustableloop surrounding said upwardly turned end portion spaced rearwardly from the end and adapted to be in spaced external relation to the external surface of the blood vessel to be tied, resilient holding means mounted on said carriage and resiliently holding the said end portion of the ligature thereon, ligature guide means in the end of said upturned clamping end portion to be located forwardly of the loop, an intermediate portion of said ligature interconnecting the loop with said resilient holding means extending through said ligature guide means such that movement of said carriage rearwardly toward the handle portion with the said end portion of the ligature connected thereto pulls the adjustable loop of the ligature in the opposite direction until it moves forwardly and upwardly off said support and surrounds the external surface of the blood vessel tightly embracing it, and cutting means mounted on said apparatus for cutting the end portion of the ligature away from the loop tied around the blood vessel.

10. The apparatus set forth in claim 9 including a trigger-shaped member rigidly connected to and depending from said carriage so that when the support is held in the hand of the operator by its handle portion a finger of the same hand can be used to squeeze the triggershaped member and move the carriage along said support toward the handle portion, whereby a ligature can be tied around the blood vessel using only one hand.

11. The apparatus set forth in claim 9 including actuating means mounted on said apparatus and in the path of said carriage, said actuating means connected to said cutting means in such a way that when the carriage moving on the support contacts it, said cutting means is operated so that by moving said carriage until it contacts said actuating means said ligature will be tied around the blood vessel and this tied portion will be severed from the apparatus.

12. The apparatus set forth in claim 11 including a trigger-shaped member rigidly connected to and depending from said carriage so that when the support is held in the hand of the operator by its handle portion a nger of the same hand can be used to squeeze the triggershaped member and move the carriage along said support toward the handle portion, and an actuating means-engaging surface formed on said trigger-shaped member, said surface contacting said actuating means to cause it to actuate said cutting means when said carriage is moved a predetermined distance toward said handle portion, whereby a ligature can be tied around the -blood Vessel and cut away from the apparatus by using only one hand to hold the apparatus and to squeeze the trigger-shaped member.

13. An apparatus -for tying a ligature to a blood vessel comprising a support, a portion of the handle of the apparatus rigidly connected to one end of said support, said handle portion including a first finger-receiving opening, a xed clamping jaw formed on the opposite end thereof and having a smooth outer surface, a movable clamping jaw pivotally mounted on said support, said movable clamping jaw positioned opposited to said xed clamping jaw to form a pair of clamping jaws adapted to hold a blood vessel therebetween, an arm rigidly connected to said movable jaw and extending toward the opposite end of said support, Said arm terminating in another portion of a handle, said another handle portion including a second finger-receiving opening, said irst and second fingerreceiving openings defining a scissors-like hemostat handle for the manipulation of the clamping jaws, a ligature connected to-and movably mounted on said support, said ligature made froma string-like material and comprising an adjustable loop and an end which when pulled decreases the size of the adjustable loop and tightens it around any article it surrounds, said adjustable loop surrounding said clamping jaws and adapted to be in spaced external relation to the external surface of the blood vessel to be tied, a carriage movably mounted on said support adjacent said smooth surfaced fixed clamping jaw for movement `between a forward position of adjustment rearwardly of the forward end of said smooth Surfaced clamping jaw and a rearward position, resilient holding means on said carriage resiliently holding the said end portion of the ligature thereon, a guide opening formed on the end of said fixed clamping jaw extending rearwardly through the jaw to a point forwardly of the forward position of adjustment of the carriage, said guide opening penetrated by a portion of said ligature connected thereto in such a way that the movement of said carriage a predetermined distance rearwardly toward said hemostat handle to the rearward posi-tion with the saidend of the ligature connected thereto would cause the said end of the ligature to pull the adjustable loop in the opposite `direction until it moved forwardly oli the jaws, surrounded the external surface of the blood vessel, and was drawn tightly around it,` and cutting means mounted on said apparatus for cutting the said end of the ligature away from the adjustable loop tied around the blood vessel. A

`14. The apparatus set forth in claim 13 including adjustable means for locking the clamping jaws together with varying degrees of compression.

References Cited in the fle of this patent UNITED STATES PATENTS 1,234,051 Lukens July 17, 1917 1,347,651 Nauth s Mar. 29, 1919 1,855,546 'File Apr. 26, 1932 1,940,351 Howard Dec. 19, 1933 2,316,297 Southerland et al Apr. 13, 1943 2,583,043 Dean Jan. 22, 1952 2,610,631 Calicchio Sept. 16, 1952 

